The development of the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework

Physical activity-the past, present and potential future: a state-of-the-art review

This is a state-of-the-art review of historical developments, current approaches and recommended future directions in physical activity (PA) research, practice and policy. Since the early epidemiological studies in the 1950s, PA research has developed from within a biomedical paradigm. There is now a strong evidence base linking PA with positive health outcomes. PA is currently understood as a multi-sector issue, requiring a multi-sector solution (e.g. transport, urban design, sport), resulting in multiple individual and societal benefits (e.g. addresses multiple Sustainable Development Goals), however, there is a disconnect between interventions, policy and practice. This may be due to limited cross-sector collaboration between, and within, the public and private sectors. Furthermore, the mix of policy instruments employed by governments to implement PA policy to date has been dominated by soft (e.g. communication) rather than hard options (e.g. fiscal). To progress in PA promotion, we need to move beyond health outcome and intervention evidence generation (e.g. focus on testing efficacy in highly controlled settings), to more complex, real world, politically informed, multi-sector, scale-up and policies, while concurrently collecting data to evaluate such efforts (e.g. natural experiments and evaluations of the policy process). PA programs may benefit from greater incorporation of public policy considerations, so that proposed interventions and policies are designed with potential political constraints in mind. We conclude by providing a call to action to advance the understanding of the role of politics in PA, in order to develop politically informed action on PA.

Worldwide Policy, Surveillance, and Research on Physical Education and School-Based Physical Activity: The Global Observatory for Physical Education (GoPE!) Conceptual Framework and Research Protocol

INTRODUCTION

The Global Observatory for Physical Education (GoPE!) builds on the Global Observatory for Physical Activity (GoPA!) to address gaps in surveillance, policy, and research on physical education (PE) and activity (PA). GoPE! is a worldwide surveillance system of quality PE and school-based PA that informs policy and interventions and allows comparative analysis so that each country and region can check their status and progress. This paper presents GoPE!'s conceptual framework and describes the research protocol as a cross-continental and evidence-based surveillance system.

METHODS

Based on GoPA!'s framework and informed by the European Physical Education Observatory, as well as framed by the socioecological model of PE, United Nations Educational, Scientific, and Cultural Organization's quality PE, and the World Health Organization's whole-of-school approach, the GoPE! stands out by providing a comprehensive methodological approach. This approach relies on independently collected data about PE and PA at school policies, surveillance systems, and research. These data are critically reviewed by local representatives of the GoPE! network of experts. The GoPE! Country Card is the main product released every 5 years. It is a 1-page infographic summary of a country's key dimensions and indicators. The dimensions are: country and demographic data, PA participation, PE policy, PE surveillance, and PE and school-based PA intervention research.

CONCLUSION

Through its vision and methodological framework, GoPE! aims to contribute to the establishment of a minimum common denominator of quality PE and school-based PA, ultimately informing promotion, advocacy, and agenda-setting efforts to achieve international goals and recommendations for more active, equitable, and healthy children and adolescents, schools, and societies.

Taking a partnership approach to embed physical activity in local policy and practice: a Bradford District case study

BACKGROUND

Supportive policy is an important component of a whole-systems approach to increasing physical activity and reducing inequalities. There is a growing body of literature surrounding the design and effectiveness of national policy approaches to physical activity, but evidence related to local-level approaches is lacking. The aim of this study was to examine 'what works', and identify factors underpinning change, focused on work to embed physical activity in local policy and practice in Bradford, UK.

METHODS

A mixed-methods case study approach involved collecting data from cross-sectoral stakeholders directly or indirectly engaged in the physical activity agenda in Bradford over a period of three years (2021-2024). Data collection included focus groups, semi-structured interviews, researcher observations of key workshops and meetings, and surveys at two time-points (December 2021 and January 2024). Qualitative data were analysed using reflexive thematic analysis. Quantitative data were analysed using descriptive and inferential statistics.

RESULTS

Four themes were identified which embody conditions that appear to be critical for working towards physical activity being embedded in local policy & practice within the Bradford District. These included: collaboration and sector integration, co-productive working, governance and leadership, and cultivating a learning culture. The process of co-producing a district-wide strategy for physical activity was key to facilitating shared ownership of the physical activity agenda across different levels of the system, and for supporting and maintaining cross-sectoral collaboration. On average, survey respondents connected with four more local organisations in relation to the physical activity agenda in January 2024 than in December 2021.

CONCLUSION

Taking a partnership approach, and fostering a culture of evidence-informed decision making, is key to embedding physical activity into policy and practice at a local level. Investing time to understand the aims and values of each partner, and potential synergies and tensions between them, can support the development of a positive and productive collaboration and, subsequently, more effective whole-system delivery and population-level increases in physical activity.

Physical activity policy implementation and physical activity levels in the European Union: Are we on track to close the gap between policy and practice?

National policies are a key starting point to achieve changes in population health. This study aimed to provide an overview of the relationship between physical activity policy implementation and the levels of sufficient physical activity across the European Union over the last decade. Data from the 23 indicators of the European Union Health-Enhancing Physical Activity Monitoring Framework established to monitor country implementation of the European Union Physical Activity Guidelines from 2015, 2018 and 2021, and physical activity prevalence data from the Special Eurobarometer on Sport and Physical Activity in 2013, 2017 and 2022 were analysed. European Union Member States significantly increased their physical activity policy implementation from 2015 to 2021 by 13.2 % (63.30 ± 18.89 versus 76.51 ± 14.94 %, p < 0.001, 95 % CI [-19.97, -6.45]). However, no significant change in levels of sufficient physical activity was found between 2013 and 2022 (60.59 ± 15.67 versus 61.70 ± 17.67 %, p = 0.360, 95 % CI [-3.61, 1.39]). Additionally, most European Union countries are not on track to meet the targeted 10 % relative reduction in levels of insufficient physical activity by 2025. Physical activity policies in the European Union do not appear to be related with the intended goal of increasing levels of physical activity. Policies may need to be reviewed and policy monitoring expanded, strengthened, and better integrated.

Navigating Physical Activity Promotion and Policy in the Post-COVID-19-Pandemic Era

BACKGROUND

There is limited evidence on the priorities and opportunities associated with promoting population physical activity (PA) participation for the post-COVID-19-pandemic future.

PURPOSE

This study assessed government-led PA promotion efforts before and during the COVID-19 pandemic, along with post-COVID-19-pandemic priorities and recommendations.

METHODS

Two separate cross-sectional surveys conducted in 2023. Survey 1 was targeted at the Global Observatory for Physical Activity (GoPA!) Country Contacts. Survey 2 also included key international informants representing influential stakeholders in PA policy implementation.

RESULTS

There were 68 respondents to Survey 1, collectively representing 61 countries. An additional 37 people, including representatives from 14 key international stakeholders responded to Survey 2. Eighty-two percent of countries had national PA policies. COVID-19 widely disrupted PA policy implementation. Less than 40% of countries integrated PA into their COVID-19 response plan and more than 75% reported policies that restricted PA participation. Although most respondents indicated that government PA priorities did not change due to the COVID-19 pandemic, one in five countries reported that cross-sectoral partnership had become more important during this period. Less than a third of postpandemic governments reported as highly engaged despite the widespread proliferation of PA policies and plans prior to the pandemic. There were variations according to country, region, and income.

CONCLUSIONS

Elevating PA promotion on the public health agenda is crucial for the post-COVID-19-pandemic era. At a policy level, it is critical to focus on adequate resourcing, cross-sectoral partnerships, integrated interventions, and inequities in participation. These factors have become increasingly important in the postpandemic PA policy landscape.

It's about time to exercise: development of the Exercise Participation Explained in Relation to Time (EXPERT) model

A perceived 'lack of time' is consistently the most commonly reported barrier to exercise. However, the term fails to capture the multifaceted nature of time-related factors. Recognising the need for a more comprehensive analysis of 'lack of time' as a barrier to exercise, the aim of this study was to develop the exercise participation explained in relation to time (EXPERT) model. The model was developed through a sequential process including (1) an umbrella literature review of time as a barrier, determinant, and correlate of physical activity; (2) a targeted review of existing temporal models; (3) drafting the model and refining it via discussions between eight authors; (4) a three-round Delphi process with eight panel members; and (5) consultations with seven experts and potential end-users. The final EXPERT model includes 31 factors within four categories: (1) temporal needs and preferences for exercise (ie, when and how long does an individual need/want to exercise), (2) temporal autonomy for exercise (ie, autonomy in scheduling free time for exercise), (3) temporal conditions for exercise (ie, available time for exercise) and (4) temporal dimensions of exercise (ie, use of time for exercise). Definitions, examples and possible survey questions are presented for each factor. The EXPERT model provides a comprehensive framework for understanding the multi-dimensional nature of 'time' as it relates to exercise participation. It moves beyond the simplistic notion of 'lack of time' and delves into the complexity of time allocation in the context of exercise. Empirical and cross-cultural validations of the model are warranted.

A systematic review of research reporting practices in observational studies examining associations between 24-h movement behaviors and indicators of health using compositional data analysis

Background

Compositional data analysis (CoDA) techniques are well suited for examining associations between 24-h movement behaviors (i.e., sleep, sedentary behavior, physical activity) and indicators of health given they recognize these behaviors are co-dependent, representing relative parts that make up a whole day. Accordingly, CoDA techniques have seen increased adoption in the past decade, however, heterogeneity in research reporting practices may hinder efforts to synthesize and quantify these relationships via meta-analysis. This systematic review described reporting practices in studies that used CoDA techniques to investigate associations between 24-h movement behaviors and indicators of health.

Methods

A systematic search of eight databases was conducted, in addition to supplementary searches (e.g., forward/backward citations, expert consultation). Observational studies that used CoDA techniques involving log-ratio transformation of behavioral data to examine associations between time-based estimates of 24-h movement behaviors and indicators of health were included. Reporting practices were extracted and classified into seven areas: (1) methodological justification, (2) behavioral measurement and data handling strategies, (3) composition construction, (4) analytic plan, (5) composition-specific descriptive statistics, (6) model results, and (7) auxiliary information. Study quality and risk of bias were assessed by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.

Results

102 studies met our inclusion criteria. Reporting practices varied considerably across areas, with most achieving high standards in methodological justification, but inconsistent reporting across all other domains. Some items were reported in all studies (e.g., how many parts the daily composition was partitioned into), whereas others seldom reported (e.g., definition of a day: midnight-to-midnight versus wake-to-wake). Study quality and risk of bias was fair in most studies (85%).

Conclusions

Current studies generally demonstrate inconsistent reporting practices. Consistent, clear and detailed reporting practices are evidently needed moving forward as the field of time-use epidemiology aims to accurately capture and analyze movement behavior data in relation to health outcomes, facilitate comparisons across studies, and inform public health interventions and policy decisions. Achieving consensus regarding reporting recommendations is a key next step.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-024-00062-8.

Physical activity policies in Saudi Arabia and Oman: a qualitative study using stakeholder interviews

BACKGROUND

Countries in the Middle East have some of the lowest rates of physical activity and some of the highest rates of obesity in the world. Policies can influence population levels of physical activity. However, there is a dearth of research on physical activity policies in the Gulf region. This qualitative study analyses cross-sectoral barriers and facilitators for the development, implementation and evaluation of physical activity policies in Saudi Arabia and Oman, two of the largest countries in the region.

METHODS

Semi-structured interviews were conducted with 19 senior policymakers from the Ministries of Health, Education, and Sport in Saudi Arabia and Oman, and were examined using thematic analysis.

RESULTS

We identified seven themes related to physical activity policies in Saudi Arabia and Oman: leadership; existing policies; physical activity programs related to policies; private sector policies; challenges; data/monitoring; and future opportunities. Both countries have a central document that guides policy-makers in promoting physical activity, and the available policies in both countries are implemented via multiple programs and initiatives to increase physical activity. Compared with Oman, in Saudi Arabia, programs from the non-profit sector, represented by community groups, play a more significant role in promoting physical activity outside the government framework. The private sector has contributed to promoting physical activity in both countries, but interviewees stated that more financial support is required. Policy limitations differ between Saudi Arabia and Oman: intersectoral collaboration in Oman is limited and mainly based on individuals' own initiative, while the health transformation in Saudi Arabia tends to slow down policy implementation in relevant areas. Physical education in Saudi Arabia and Oman is similar; however, increased support and collaboration between government agencies and the private sector for out-of-school sports academies are needed.

CONCLUSIONS

This study addresses key gaps in analysing physical activity policies in Gulf Cooperation Council countries. Our study highlights the importance of increasing financial support, improving collaboration between governmental agencies and between them and the private sector and consolidating efforts to back physical activity policies and dismantle cross-sectoral barriers in Saudi Arabia and Oman. Educational institutions in Saudi Arabia and Oman play a crucial role in promoting physical activity from early childhood to young adults. Our insights assist policy-makers, public health officials and stakeholders in shaping effective physical activity-promoting policies, programs and interventions to prevent non-communicable diseases. Challenges identified in Saudi Arabia and Oman's policies will inform their future development.

Social value framing of physical activity in European Member State policies: a content analysis

Background

Engagement in physical activity (PA) benefits physical and mental health as well as many other areas of society. In Europe however, 1/3 adults do not meet minimum PA recommendations. Social value, and its quantification through social return on investment (SROI) evidence, may be a useful framing to enhance PA promotion. This study aimed to assess the current use of social value framing of PA in European Union (EU) policies.

Methods

Content analysis of 45 EU member state policies which contain reference to PA was conducted to evaluate the presence of five social value domains and SROI evidence. Data was analysed using manual inductive coding, supported by DeepL translation and NVivo tools.

Results

Social value framing was present to a certain extent in existing policies, with improved health being the most commonly referenced benefit of PA, followed by reference to social and community and then environmental benefits. Acknowledgement of the positive impacts of PA on wellbeing and education was the least present. Reference to SROI evidence was also limited. Generally, policies lacked holistic recognition of the social value of PA. Policies from the health sector were particularly limited in recognising the wider benefits of PA, whilst those from the environmental sector acknowledged the widest range of co-benefits.

Conclusion

Adopting social value framing could be a useful approach for enhancing PA promotion. Whilst it is present to a certain extent in existing policy, this could be increased in terms of comprehensiveness to increase issue salience and multisectoral policy action.

Supporting health and wellbeing in health care employees: a documentary review of organizational policies, strategies and frameworks

Background

Health care workers are crucial for a productive and thriving health care system, yet the health and lifestyle behaviour of key groups within this workforce (for example nurses and healthcare assistants/support workers) is typically poor. The extent of health and wellbeing documents that guide action towards improving their health and wellbeing is unknown. Using one health care system, NHS Scotland, as an example, the aim of this study was to assess the number of NHS health boards with workplace documents focused on health and wellbeing of employees, the quality of these documents and the extent to which they reference lifestyle behaviours, namely physical activity.

Methods

Documentary analysis was undertaken on employee health and wellbeing policies (and wider documents). These were sourced through online searches on Google search engine and Freedom of Information Requests sent to all 14 Scottish NHS Health Boards. Titles and content were assessed for relevance to employee health and wellbeing. Content analysis was used to analyse the included documents against eight predefined codes.

Results

Thirteen documents were retrieved with 11 of the 14 Health Boards having at least one relevant document. The content varied greatly between documents with regards to how many reported the eight codes and the quality of content within these. Nine documents mentioned physical activity but mainly in relation to current activities rather than in the context of a future healthy workforce.

Conclusions

Despite the importance of a healthy, health care workforce, more work is needed to ensure high level documents are able to support these efforts, especially with reference to lifestyle behaviours.

Physical Activity Policies at National and Subnational Levels: A Study in Colombia, Costa Rica, Ecuador, and Mexico

BACKGROUND

National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national-subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries.

METHODS

The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were assessed using descriptive statistics.

RESULTS

Twenty-three (response rate = 85.2%) informants provided data, mainly from the health sector (52.2%), followed by the sport (26.1%), transport (13.0%), and education (8.7%) sectors. Most informants reported that their countries had a current PA policy embedded within noncommunicable diseases prevention plans (46.2%), other plans (46.2%), or obesity prevention/management/control plans (7.7%). Respondents at the subnational level rated PA promotion as central (64.3%), while the national-level role was important but not central (75.0%). National and subnational policymakers indicated low-to-little involvement in the other level's PA policy processes across the 5 policy stages.

CONCLUSIONS

This study demonstrated that collecting national and subnational PA policy data across countries with the active collaboration of the GoPA! network was feasible. We also successfully identified governmental interactions throughout the PA policy process, suggesting suboptimal engagement between national and subnational levels.

Breaking Barriers: An Innovative Tool to Assess the National and City-Level Physical Activity Policy Development to Practice Disconnect

BACKGROUND

Population-level physical activity increases are improbable without intersectoral collaboration across government levels and sectors to develop and implement physical activity promotion policies. This study aims to provide information about the development of the Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool (INTEGRATE PA-Pol). A framework was created to examine the development and implementation of national and subnational physical activity policies and the (mis)alignment between government levels.

METHODS

The work was conducted in 3 phases: (1) a scoping review was carried out to identify local government physical activity promotion policies and instruments for assessing them, (2) an expert group designed 6 questionnaires, and (3) cognitive response testing was employed for validity testing and item modification with a panel of research and policy experts.

RESULTS

The INTEGRATE PA-Pol Tool consists of 6 questionnaires assessing how national and subnational governments collaborate to develop and implement physical activity promotion policies.

CONCLUSION

This tool can assist in better understanding the development and implementation of a public policy monitoring system that will allow for benchmarking and priority setting to comprehend how physical activity promotion policies are designed and executed.

[Barriers and facilitators to physical activity in oncology in Seine-Saint-Denis: A qualitative study using the socio-ecological approach]

INTRODUCTION

Despite the undeniable benefits of physical activity during and beyond cancer treatments, patients do not always undertake and/or maintain it. The aim of the study is to identify, describe and understand the barriers and facilitators of physical activity practice among adults arriving at the end of treatment for solid cancer, in precarious situations, living in Seine-Saint-Denis.

METHODS

The study was conducted using a descriptive qualitative phenomenological method involving semi-directed interviews with 23 participants during and beyond cancer.

RESULTS

Multiple-level factors (micro, meso, macro) are involved in active behavior of patients. Three main facilitators were identified: perceived benefit, social support, and urban planning. Three barriers are identified: (1) physical and psychological disorders whether or not related to cancer and its treatment, (2) precariousness, organizational constraints, unfavorable social environment, (3) lack of coordination, lack of accurate and appropriate information, lack of realistic referral to physical activity offers.

DISCUSSION

A diversity of representations, combinations of factors, and experiences are described. Getting people with cancer to engage in and maintain long-term physical activity is a complex task, requiring multidisciplinary action on all socio-ecological factors.

Research- vs. government-driven physical activity policy monitoring: a systematic review across different levels of government

BACKGROUND

Even though the importance of physical activity policy monitoring has increased in the last decade, there is a lack of understanding what different approaches exist and which methodology they employ. In order to address this research gap, this review attempts to map existing approaches of physical activity policy monitoring and to analyse methodological aspects, especially with regards to the roles of governments and researchers.

METHODS

A systematic search was conducted in five scientific databases (PubMed, Scopus, SportDiscus, Psycinfo, Web of Knowledge) in July 2021, and the identified records were screened independently by two reviewers. Records were included if they (a) focused on the monitoring of public policies to promote PA, (b) allowed to compare policies across time, across nations/regions or across policy sectors, and (c) were written in English, German or Russian. During full text analysis, information on methodological aspects was extracted and studies were categorized based on the level of government involvement.

RESULTS

The search yielded in a total of 112 studies. 86 of these studies (76.8%) followed a research-driven approach (little or no government involvement) while only two studies (1.8%) were based on a government-driven approach (led by governments). The remaining 24 studies (21.4%) were based on a co-production approach (strong collaboration between researchers and governments). All in all, 18 different tools for physical activity policy monitoring were identified; key examples are the Report Cards on Physical Activity for Children and Youth (research-driven approach), the HEPA Monitoring Framework (government-driven approach) and the HEPA Policy Audit Tool (co-production approach).

CONCLUSIONS

The level of government involvement in policy monitoring differs significantly, and research-driven, government-driven and co-production approaches can be distinguished. These approaches have different strengths and weaknesses, and can be linked to distinct theories of change and models on research-policy relations. Increasing awareness on the implications of these approaches is key to improve the understanding and further development of physical activity policy monitoring.

Policy Analysis of Return to Learn After Sport and Recreational Related Concussion for Secondary Schools in New England: Relevance to School Nurses and Nursing Practice

Return to learn (RTL) is the individualized process of coordinating cognitive care and reintegration for students into the academic setting after any sport and recreational-related concussion (SRRC). The guidelines for RTL are based on empirical evidence, however, implementation differs by institution. The purpose of the policy analysis is to evaluate RTL guidelines after SRRC of student-athletes in New England secondary school public school systems. A review of the six New England states' policies surrounding RTL was conducted. The Comprehensive Analysis of Physical Activity Framework was referenced to identify the analytic components of existing legislation and because of the relatively new implementation of RTL-specific policy, a novel policy analysis tool was utilized. States with RTL-specific language scored on average 7.9 to 11.1 points higher when compared to states without RTL-specific language. This difference was associated with disparities in access to RTL resources for residents according to their geographic location. Lobbying efforts should be targeted toward states without RTL-specific language to provide equal care and opportunities for student-athletes to receive RTL services. RTL policy provides a responsibility to assist students who have suffered from an SRRC and can serve to improve health outcomes and academic achievement.

Assessing physical activity promotion in different settings and how its associated with public participation during COVID-19 epidemic: evidence from national policy evaluation

BACKGROUND

Various interventions, programs and policies have been implemented to improve physical activity (PA) levels worldwide. However, countries continue to face barriers and challenges in achieving their targets. To date, there is a lack of study on the evaluation of physical activity (PA) promotion and how it's associated with public participation.

METHODS

This study assessed PA promotion in eight different settings in terms of policy availability, policy implementation, and public participation in PA programs. Policy availability was assessed by reviewing 384 policy and strategy documents, rules, regulations, legislation, and guidelines on PA. We scored the documents by using the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. Data to assess policy implementation and public participation were taken from the Thailand Report Card Survey 2021 (TRC2021), and the Thailand Surveillance on Physical Activity (SPA) 2021. Both surveys comprised over 5,000 nationally-representative samples from on-screen, face-to-face interviews, and an online self-administered survey. We scored the policy implementation and public participation based on respondents' response towards policy implementation and participation indicators. A grading scheme was applied to indicate how successful an investment has been made.

RESULTS

Public education and mass media received the highest average score in policy availability, implementation and public participation in PA program (67.9%, grade B), followed by active urban design (66.1%, grade B-) and active transport (63.7%, grade B-). Workplace, whole-of-school, and community-wide initiatives were the investments with the lowest scores, implying low availability, limited implementation, and less accessibility to public. Females were less likely to participate in active transport, active urban design, sports/recreation for all, workplace activity, and community-wide initiatives. Age and educational attainment were consistent predictors of utilization in all investments.

CONCLUSIONS

With varying degrees of policy availability and accessibility, public participation in PA investments is likely to be constrained by biological and socioeconomic inequality. Future investments should aim at providing generalized or tailored interventions to ensure equal access and participation for all segments of the population.

Assessing the implementation of physical activity-promoting public policies in the Republic of Ireland: a study using the Physical Activity Environment Policy Index (PA-EPI)

BACKGROUND

Government policy can promote physical activity (PA) as part of a multilevel systems-based approach. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework which assesses the implementation of government policy by drawing on the experience of national stakeholders. This study is the first to assess the extent of policy implementation in the Republic of Ireland using the PA-EPI tool, and to provide information on how policy implementation can be improved, with the intention of maximizing its impact on population levels of PA.

METHODS

This mixed-methods research study, comprising eight steps, was carried out in 2022. Information documenting the evidence for implementation of PA policy, across all 45 PA-EPI indicators, was collected via systematic document analysis, and validated via survey and interview with government officials. Thirty-two nongovernment stakeholders rated this evidence on a five-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identified and prioritized critical implementation gaps.

RESULTS

Of the 45 PA-EPI indicators, one received an implementation rating of 'none/very little', 25 received a rating of 'low' and 19 received a 'medium' rating. No indicator was rated as fully implemented. The indicators that received the highest level of implementation related to sustained mass media campaigns promoting PA and PA monitoring. Ten priority recommendations were developed.

CONCLUSIONS

This study reveals substantial implementation gaps for PA policy in the Republic of Ireland. It provides recommendations for policy action to address these gaps. In time, studies utilizing the PA-EPI will enable cross-country comparison and benchmarking of PA policy implementation, incentivizing improved PA policy creation and implementation.

National policies on physical activity from 64 countries with different economies: a scoping review with thematic analysis

In 2018, the World Health Organization (WHO) launched a Global Action Plan on Physical Activity (PA), which included 20 policy actions for creating active societies, environments, people and systems. The objective of this scoping review was to summarize the themes/contents of national PA policies/plans conforming to the WHO's proposals and the country's economy. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. A systematic search of electronic databases (Web of Science, Medline/PubMed, LILACS, PsycINFO, Scopus and SPORTDiscus) and 441 government documents/websites from 215 countries/territories was conducted (February 2021). Documents on national-level policies, published in English, Spanish and Portuguese since 2000, were eligible. The information on content and structure was systematically extracted and summarized into dimensions proposed by the WHO: active societies, environments, people and systems. The search identified 888 article references and 586 potentially relevant documents. After the screening, 84 policy documents from 64 countries were eligible. Most documents (n = 46) provided detailed PA policies/plans amid other health topics (e.g. non-communicable diseases, named 'general documents'), and 38 were PA-specific. The content analysis merged 54 visions, 65 missions, 108 principles, 119 objectives, 53 priorities, 105 targets, 126 indicators and 1780 actions/strategies from 38 PA-specific and 46 general documents. Among the PA-specific documents, the active system's dimension was the most contemplated in the principles (n = 43), priorities (n = 51) and action/strategies (n = 530) elements. At the same time, the objectives (n = 39), targets (n = 52) and indicators (n = 58) presented contents more frequently related to the active people dimension. For the general documents, all principles (n = 4), objectives (n = 14) and priorities (n = 7) were related to the dimension of active people, while target (n = 51), indicator (n = 53) and actions/strategies (n = 292) elements presented content related to all dimensions. The increase in countries with national PA policies/plans should be followed by improving the current ones because important dimensions seem to be not considered in these documents. This will facilitate a global PA agenda that considers the complexity and multidimensionality of PA promotion.

Physical Activity of Children and Adolescents in Croatia: A Global Matrix 4.0 Systematic Review of Its Prevalence and Associated Personal, Social, Environmental, and Policy Factors

BACKGROUND

The previous review of physical activity (PA) among Croatian children and adolescents was conducted a decade ago. Therefore, the aim of this study was to summarize recent evidence on PA of Croatian children and adolescents and associated personal, social, environmental, and policy factors.

METHODS

Eighteen experts reviewed the available evidence and provided ratings (from the lowest grade "F" to the highest grade "A+") for the 10 Global Matrix indicators. A systematic search with 100 keywords was conducted in Hrčak, PubMed/MEDLINE, Scopus, SPORTDiscus, and Web of Science for documents published from January 01, 2012, to April 15, 2022. We also conducted internet searches and secondary analyses of data (relative frequencies) from 6 studies.

RESULTS

After assessing 7562 references, we included 90 publications in the review and 18 studies (83.3% of medium-to-good quality) in evidence synthesis. We found a high prevalence of insufficient PA (especially among girls) and excessive screen time (especially among boys). PA participation of children and adolescents in Croatia has declined over time. The following grades were assigned to the indicators for Croatia: B- for overall PA, C- for organized sport and PA, C for active play, C- for active transportation, D+ for sedentary behavior, inconclusive for physical fitness, D+ for family and peers, B- for school, B- for community and environment, and D+ for government.

CONCLUSIONS

Coordinated actions are needed across sectors to improve PA promotion, with a focus on increasing PA among girls, reducing sedentary screen time among boys, improving parental support for PA, and further development of national PA policies.

Analysis of national physical activity and sedentary behaviour policies in China

PURPOSE

The aims of this study were to advance knowledge on physical activity (PA) and sedentary behaviour (SB) policies in China and to highlight related gaps and opportunities in the Chinese policy landscape.

METHODS

Literature and web-based searches were performed to identify national PA and SB policies in China. We assessed which of the 17 elements of the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT, version 2) are included in each of the policy documents and whether and how they address the 'cornerstones' of PA and SB policy: PA and SB guidelines, targets, surveillance and monitoring, and public education programmes.

RESULTS

We found 60 national PA and SB policies, of which 54 focused on PA only and 6 focused on both PA and SB. There was a rapid increase in the number of policies issued between 2002 and 2021. In totality, the policies include all 17 key elements for a successful national policy approach to PA promotion according to the HEPA PAT. The policies reflect engagement from a range of sectors and encompass PA targets, recommendations for PA and SB, mandates and recommendations for school-related PA, plans for public education on PA, and plans for surveillance and monitoring of PA and SB.

CONCLUSION

Our findings demonstrate that there has been increasing focus on PA and SB policies in China, which reflects efforts by policymakers to address the health burden of insufficient PA and excessive SB. More emphasis may be placed on SB in Chinese policy, particularly in terms of setting specific targets for population SB. Policymakers and other relevant public health stakeholders in China could also consider developing or adopting the 24-hour movement guidelines, in accordance with recent trends in several other countries. Collaboration and involvement of different sectors in the development and implementation of Chinese PA and SB policies should continue to be facilitated as part of a whole-of-system approach to health promotion.

Formative assessment: Is Australia ready for a physical activity surveillance system?

OBJECTIVES

This study investigated the feasibility of establishing a comprehensive and standardised physical activity surveillance system (PASS) in Australia to guide policy and programs to address this public health priority.

METHODS

We gathered information about existing data and reporting obligations in relation to physical activity, by conducting cross-sectoral workshops for each state and territory. This information was synthesised by sector/domain using the socioecological model. We developed a set of potential PASS indicators for feedback from the policymakers in the National Physical Activity Network.

RESULTS

Jurisdictions identified existing physical activity-relevant surveillance measures across socioecological levels and sectors. The most common were individual behavioural measures; less common were interpersonal, settings, environmental, and policy measures. Feedback was gathered from policymakers about model indicators that could be considered in future discussions.

CONCLUSIONS

Our findings reveal areas where data availability is most widespread as well as areas of deficiency. Although this process identified relevant cross-sectoral indicators, further feasibility assessment will require national-level discussions, cross-agency planning, and leadership by Federal and State governments to progress PASS discussions further.

IMPLICATIONS FOR PUBLIC HEALTH

The existing physical activity surveillance system in Australia is fragmented and lacks nationwide standardisation. Most physical activity surveillance focuses on individual behaviours, and limited monitoring occurs of broader elements of the "physical activity system." Improvements will contribute to more informed and accountable decision-making and enable more effective monitoring of progress at multiple levels towards achieving state and national physical activity goals. Policymakers need to embrace this agenda and further the discussions on the scope, shape, and structure of a physical activity surveillance system.

Movement behavior policies in the early childhood education and care setting: An international scoping review

Background

Meeting 24-h movement behavior guidelines for the early years is associated with better health and development outcomes in young children. Early childhood education and care (ECEC) is a key intervention setting however little is known about the content and implementation of movement behavior polices in this context. To inform policy development this international scoping review examined the prevalence, content, development and implementation of ECEC-specific movement behavior policies.

Methods

A systematic literature search of published and gray literature since 2010 was conducted. Academic databases (EMBASE, Cinahl, Web of Science, Proquest, Scopus, EBSCO, PubMed) were searched. A Google search was undertaken and limited to the first 200 results. The Comprehensive Analysis of Policy on Physical Activity framework informed data charting.

Results

Forty-three ECEC policy documents met inclusion criteria. Most policies originated in the United States, were subnational and developed with government, non-government organizations and ECEC end-users. Physical activity was specified in 59% (30-180 min/day), sedentary time in 51% (15-60 min/day) and sleep in 20% (30-120 min/day) of policies. Daily outdoor physical activity was recommended (30-160 min/day) in most policies. No policy permitted screen time for children <2 years, with 20-120 min/day for children >2 years. Most policies (80%) had accompanying resources but few provided evaluation tools (e.g., checklists; action plan templates). Many policies had not been reviewed since the publication of 24-h movement guidelines.

Conclusion

Movement behavior policies in the ECEC setting are often vaguely worded, missing a comprehensive evidence base, siloed in development and often not tailored for the 'real world.' A focus on evidence informed ECEC-specific movement behavior policies proportionally aligned with national/international 24-h Movement Behaviors Guidelines for the Early Years is needed.

Mapping and analysis of laws influencing built environments for walking and cycling in Australia

BACKGROUND

Physical inactivity is a significant public health concern, with limited signs of improvement despite a global commitment to achieving the World Health Organization's target of 15% reduction by 2030. A systems approach is required to tackle this issue, involving the creation of environments that are conducive to physical activity. Laws represent an important tool for regulating the built environment for physical activity, are a mechanism for systems change, and have the capacity to reorient the goals and rules of a system. However, they are understudied and potentially underutilised for physical activity. Scientific legal mapping is a first step towards understanding how laws could impact the built environment to facilitate greater population physical activity.

METHOD

We conducted a legal assessment of state and territory laws in Australia, to systematically characterise how they address built environment considerations with specific relevance to walking and cycling. An interdisciplinary team of researchers with public health, law and urban planning expertise was formed to complete the multistage process. Key steps included a systematic search of laws using a combination of original legal research, consultation of secondary sources, and review and verification by an urban planning expert; development of a coding scheme; and completion of coding and quality control procedures.

RESULTS

Most jurisdictions in Australia do not currently embed objectives in primary legislation that would promote physical activity and support an integrated approach to land use and transport planning that encourages active and sustainable lifestyles. Only two jurisdictions addressed the large majority of evidence-based standards that promote active living. Of the standards addressed in law, few fully met evidence-based recommendations. While most jurisdictions legislated responsibility for enforcement of planning law, few legislated obligations for monitoring implementation.

CONCLUSION

Increasing physical activity is a systems issue, requiring actions across multiple sectors. An in-depth examination of the legal environment is an important step towards understanding and influencing the existing physical activity system, why it may not be generating desired outcomes, and potential opportunities for improvement. Our findings reveal opportunities where laws could be strengthened to promote more active environments. Updating this dataset periodically will generate longitudinal data that could be used to evaluate the impact of these laws on the built environment and physical activity behaviours.

Towards a harmonized European surveillance for dietary and physical activity indicators in young and adult populations

BACKGROUND

The Policy Evaluation Network proposes a consolidated approach to measure comparable health indicators across European health surveillance systems to evaluate effectiveness of policy action.

METHODS

In a stepwise approach, questionnaire items used by the systems for measuring diet and physical activity data to describe health indicators were identified based on their validity, reliability, and suitability to monitor achievement of health recommendations. They were collated to unified questionnaire modules and discussed bilaterally with representatives of these systems to explore barriers and facilitators for implementation. Also, establishment of a methodological competence platform was proposed, in which the surveillance and monitoring systems agree on the priorities and common quality standards for the harmonization process and to coordinate the integration of questionnaire modules into existing systems.

RESULTS

In total, seven questionnaire modules were developed, of which two diet and two physical activity modules were proposed for implementation. Each module allows measurement of data reflecting only partial aspects of national and WHO recommendations related to diet and physical activity. Main barriers were the requirements of systems to monitor temporal trends and to minimize costs. Main facilitator for implementation was the systems' use of questionnaire items that were comparable to the unified modules. Representatives agreed to participate in a methodological competence platform.

CONCLUSION

We successfully took first steps in the realization of the roadmap towards a harmonization of European surveillance by introducing unified questionnaire modules allowing the collection of comparable health indicators and by initiating the establishment of a competence platform to guide this process.

The Physical Activity Environment Policy Index for monitoring government policies and actions to improve physical activity

BACKGROUND

A multifaceted response, including government action, is essential to improve population levels of physical activity (PA). This article describes the development process of the 'Physical Activity Environment Policy Index' (PA-EPI) monitoring framework, a tool to assess government policies and actions for creating a healthy PA environment.

METHODS

An iterative process was undertaken. This involved a review of policy documents from authoritative organizations, a PA policy audit of four European countries, and a systematic review of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops were conducted, where quantitative and qualitative data, alongside theoretical and pragmatic considerations, were used to inform PA-EPI development.

RESULTS

The PA-EPI is conceptualized as a two-component 'policy' and 'infrastructure support' framework. The two-components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development and health-in-all-policies. Forty-five 'good practice statements' or indicators of ideal good practice within each domain conclude the PA-EPI. A potential eight-step process for conducting the PA-EPI is described.

CONCLUSIONS

Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI good practice statements will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.

Built Environments And Child Health in WalEs and AuStralia (BEACHES): a study protocol

INTRODUCTION

Childhood obesity and physical inactivity are two of the most significant modifiable risk factors for the prevention of non-communicable diseases (NCDs). Yet, a third of children in Wales and Australia are overweight or obese, and only 20% of UK and Australian children are sufficiently active. The purpose of the Built Environments And Child Health in WalEs and AuStralia (BEACHES) study is to identify and understand how complex and interacting factors in the built environment influence modifiable risk factors for NCDs across childhood.

METHODS AND ANALYSIS

This is an observational study using data from five established cohorts from Wales and Australia: (1) Wales Electronic Cohort for Children; (2) Millennium Cohort Study; (3) PLAY Spaces and Environments for Children's Physical Activity study; (4) The ORIGINS Project; and (5) Growing Up in Australia: the Longitudinal Study of Australian Children. The study will incorporate a comprehensive suite of longitudinal quantitative data (surveys, anthropometry, accelerometry, and Geographic Information Systems data) to understand how the built environment influences children's modifiable risk factors for NCDs (body mass index, physical activity, sedentary behaviour and diet).

ETHICS AND DISSEMINATION

This study has received the following approvals: University of Western Australia Human Research Ethics Committee (2020/ET000353), Ramsay Human Research Ethics Committee (under review) and Swansea University Information Governance Review Panel (Project ID: 1001). Findings will be reported to the following: (1) funding bodies, research institutes and hospitals supporting the BEACHES project; (2) parents and children; (3) school management teams; (4) existing and new industry partner networks; (5) federal, state and local governments to inform policy; as well as (6) presented at local, national and international conferences; and (7) disseminated by peer-reviewed publications.

Results from the Thailand 2022 report card on physical activity for children and youth

Background/objective

The effort to create physical activity (PA) opportunities for Thai youth, prior to 2020, was making good progress. However, the unexpected advent of the Covid-19 epidemic has posed significant challenges to maintain PA level of youth. The Thailand 2022 Report Card on Physical Activity for Children and Youth presents measurements of PA-related indicators based on the Global Matrix, with additional indicators that are relevant for childhood development.

Methods

Several data sources were employed to develop the indicators, namely: 1) The Thailand Report Card Survey 2021; 2) School health and facility data; 3) Student health indicators from the Ministry of Public Health; and 4) Relevant resources to support the development of the policy indicator.

Results

Overall, only 27% of Thai children and youth met the 60-min PA daily threshold (grade D). While behavioral indicators were mostly graded ‘poor’ (between C and F), the source of influence (i.e., family) indicators showed better grades (between A and C). One-third (33%) of the youngsters suffered from moderate-to-severe level of stress/anxiety (grade B). Overweight and sleep indicators received grades of A or A-, whereas bullying and student engagement received a grade of B. The performance on the physical literacy indicator was graded C+.

Conclusion

With the main message “Let's Move - Boost Happiness,” the results from Thailand 2022 Report Card call for a collaborative effort involving multiple sectors to improve PA and happiness of children and youth. A more comprehensive PA promotion strategy is required to provide clear direction and guidance for schools, families, and communities in order to maintain gains and raise the overall level of youth PA in Thailand.

Physical Activity Level and Social-Ecological Influence Factors in Chinese Information Technology Professionals: A Cross-Sectional Study

Objective

Information technology (IT) population in China has expanded rapidly in recent decades, which has suffered severe health problems due to a lack of physical activity (PA). However, little is known about the influence and solutions of PA deficiency. The current research was designed to explore the associations between the amount of PA and potential influenced factors based on the social-ecological model (SEM) and thus to provide rationales for PA promotion.

Method

Six hundred and five IT professionals from five cities of China were surveyed in terms of PA in daily life as well as the potential PA influence factors based on SEM models that consisted of individual, interpersonal, environmental, and political levels in the current study. Hierarchical linear regression analyses were conducted to examine the association of the potential PA influence factors and PA amount.

Result

About 54.7% of the sample did not fulfill the PA recommendation of 600 MET per week, and there are significant gender differences in PA participation. Factors related to the individual (self-efficacy and value recognition), interpersonal (social support), environmental (workplace and community environment), and polity-level factors (policy advocacy) were found to be significantly associated with Chinese IT professionals' participation in PA.

Conclusion

Numerous correlates from individual-level to political-level factors are all important predictors of PA. Exercise value recognition and self-efficacy accounted for much of the association. Environmental variables may further influence exercise behavior. Therefore, conducting intervention efforts for individual, interpersonal, environmental, and political change of Chinese IT professionals is recommended.

Development of the health promoting sports club-national audit tool

Background

Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs.

Methods

A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus.

Results

Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders.

Conclusion

To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Assortment of Airports’ Sustainability Strategy: A Comprehensiveness Analysis Framework

Global sustainability challenges are transforming 21st century business. Economic, social, and environmental sustainability impacts regulatory agencies and enterprises, particularly in the air transport industry, which facilitates access to productive services and market linkage. Stakeholders, shareholders, consumers, employees, and society are increasingly pressuring businesses to examine their socioeconomic consequences and manage them sustainably and resiliently. In this competitive and economically sensitive climate, good management is a primary responsibility for airport operators and authorities, as well as national and local economies. An assessment tool for airport strategic plans is developed in this research. Corporate activities can encourage responsible infrastructure development and company sustainability. The assessment methodology is based on a comparative analysis between airports and regulatory authorities’ threshold. The role of sustainability in the air transport business ecosystem is depicted using a systemic approach, demonstrating that its relationship to business performance is a significant barrier to business resilience and competition for planners, managers, and decision makers. The numerical application considers a group of European, U.S, and Asian airports serving international flights. Conventional wisdom is to provide the evaluation analysis framework for planning and managing capital-intensive transport hubs such as airports.

Promoting Physical Activity Policy: The Development of the MOVING Framework

BACKGROUND

Considering the large health burden of physical inactivity, effective physical activity promotion is a "best buy" for noncommunicable disease and obesity prevention. The MOVING policy framework was developed to promote and monitor government policy actions to increase physical activity as part of the EU Horizon 2020 project "Confronting Obesity: Co-creating policy with youth (CO-CREATE)."

METHOD

A scanning exercise, documentary review of key international policy documents, and thematic analysis of main recommendations were conducted. Themes were reviewed as part of a consultation with physical activity experts.

RESULTS

There were 6 overarching policy framework areas: M-make opportunities and initiatives that promote physical activity in schools, the community, and sport and recreation; O-offer physical activity opportunities in the workplace and training in physical activity promotion across multiple professions; V-visualize and enact structures and surroundings that promote physical activity; I-implement transport infrastructure and opportunities that support active societies; N-normalize and increase physical activity through public communication that motivates and builds behavior change skills; and G-give physical activity training, assessment, and counseling in health care settings.

CONCLUSIONS

The MOVING framework can identify policy actions needed, tailor options suitable for populations, and assess whether approaches are sufficiently comprehensive.

[Policies to promote physical activity in Germany : An analysis based on a policy audit tool from the World Health Organization]

BACKGROUND

Physical inactivity is a key determinant of noncommunicable diseases. Therefore, the World Health Organization (WHO) as well as researchers worldwide have developed different tools to monitor and audit policies to promote physical activity. However, these tools have so far not been used to systematically collect and analyse data on physical activity promoting policies in Germany.

AIM

This study aims to provide a systematic overview of policies to promote physical activity in Germany.

METHODS

The study was conducted as part of the Policy Evaluation Network ( www.jpi-pen.eu ). Data from the European Union Physical Activity Monitoring Framework, desk research, and an expert survey were utilised and collected with the WHO's health-enhancing physical activity (HEPA) policy audit tool (PAT).

RESULTS

The results highlight the wide range of relevant stakeholders and provide an overview of current policies as well as surveillance, evaluation, and funding. Significant accomplishments and persistent challenges are identified.

DISCUSSION

An international comparison shows that, in contrast to Germany, other countries have formulated measurable goals for physical activity promotion on a national level. However, Germany is among a minority of countries with specific physical activity recommendations for adults with noncommunicable diseases. Further structural development of physical activity promotion in Germany is necessary.

A Critique of National Physical Activity Policy in Oman Using 3 Established Policy Frameworks

BACKGROUND

This paper aimed to assess the development process, content, and early implementation of Oman's national physical activity plan of action to identify strengths and areas for improvement.

METHODS

Data were extracted from 4 documents: national noncommunicable diseases policy, physical activity plan of action, and 2 World Health Organization Mission Reports. Three policy frameworks and approaches (physical activity content analysis grid, health-enhancing physical activity policy audit tool, and policy cube approach for diet-related noncommunicable diseases) were used.

RESULTS

The findings demonstrated that policymakers engaged a broad range of sectors in developing a national plan. It aligned with many of the elements from the 3 policy frameworks (ie, multisectoral approach, political commitment/leadership, identification of national goals and targets, time frame for implementation). The main gaps included the lack of a specified sustainable funding mechanism, systems for monitoring progress, and an emphasis on general interventions, with limited focus on specific target groups.

CONCLUSION

A range of sectors were engaged in the development of Oman's national physical activity plan of action, with strong political commitment and using global guidance and local evidence. Establishing a strong accountability framework, including a clear financing mechanism, is critical for Oman to meet its target for a 10% relative reduction in physical inactivity by 2025.

A modified Delphi study to enhance and gain international consensus on the Physical Activity Messaging Framework (PAMF) and Checklist (PAMC)

INTRODUCTION

Physical activity messaging is an important step in the pathway towards improving population physical activity levels, but best practice is not yet understood. A gap in the literature exists for a physical activity messaging framework to help guide creation and evaluation of messages. This study aimed to further develop and improve, and gain international expert consensus on, a standardised Physical Activity Messaging Framework and Checklist.

METHODS

A modified Delphi study consisting of three online survey rounds was conducted. Each survey gathered feedback from an international expert panel using quantitative and qualitative methods. The framework and checklist were amended between each round based on survey results until consensus (defined a priori as 80% agreement) was reached.

RESULTS

The final expert panel (n = 40, 55% female) came from nine countries and comprised academics (55%), healthcare and other professionals (22.5%) and government officials or policymakers (22.5%). Consensus was reached in survey 3 with 85 and 87.5% agreement on the framework and checklist, respectively.

CONCLUSION

This study presents an expert- and evidence-informed framework and checklist for physical activity messaging. If used consistently, the Physical Activity Messaging Framework and Checklist may improve practice by encouraging evidence-based and target audience-focused messages, as well as enhance the research base on physical activity messaging by harmonising key terminologies and improving quality of reporting. Key next steps include further refining the Physical Activity Messaging Framework and Checklist based on their use in real-world settings.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Selection of key indicators for European policy monitoring and surveillance for dietary behaviour, physical activity and sedentary behaviour

BACKGROUND

A pan-European approach to evaluate policy impact on health behaviour requires the employment of a consensus set of established and relevant indicators.

METHODS

As part of the Joint Programming Initiative on a Healthy Diet for a Healthy Life, the Policy Evaluation Network PEN identified key indicators of health behaviours and their determinants. These key indicators are already, or have the potential to be, adopted by large European Union surveillance systems for the assessment of policy impact. The iterative selection process included consultations in two rounds via email prior to a 2-days expert workshop. The experts collated a list of dietary behaviour, physical activity and sedentary behaviour indicators for European policy monitoring in young and adult populations based on existing frameworks and literature reviews. The expert panel was composed of researchers, policy makers and representatives of major European surveillance systems and related initiatives, as well as, representatives of organisations providing monitoring data, such as the European Commission and Eurostat.

RESULTS

The process provided two lists of key indicators including 37 diet 'policy' indicators and 35 indicators for dietary behaviour and their 'determinants'; as well as 32 physical activity 'policy' indicators and 35 indicators for physical activity, sedentary behaviour and their 'determinants'.

CONCLUSION

A total of 139 key indicators related to the individual, the setting and the population level, and suitable for the assessment of dietary behaviour, physical activity and sedentary behaviour were prioritised by policy makers and researchers with the ultimate aim to embed policy evaluation measures in existing surveillance systems across the European Union. In a next step, data sources and suitable instruments will be identified to assess these key indicators.

The added value of using the HEPA PAT for physical activity policy monitoring: a four-country comparison

BACKGROUND

Public policy is increasingly recognized as an important component of physical activity promotion. This paper reports on the current status of physical activity policy development and implementation in four European countries based on the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) developed by WHO. It compares the findings to previous studies and discusses the general utility of this tool and its unique features in relation to other instruments.

METHODS

The study was conducted as part of the Policy Evaluation Network ( www.jpi-pen.eu ) in Germany, Ireland, the Netherlands and Poland. Data collection built upon information obtained via the EU Physical Activity Monitoring Framework survey, additional desk research and expert opinion. Data analysis employed Howlett's policy cycle framework to map and compare national physical activity policies in the four countries.

RESULTS

In all countries under study, policy agenda-setting is influenced by prevalence data from national health monitoring systems, and the sport and/or health sector takes the lead in policy formulation. Key policy documents were located mainly in the health sector but also in sport, urban design and transport. Physical activity programmes implemented to meet policy objectives usually cover a broad range of target groups, but currently only a small selection of major policies are evaluated for effectiveness. National experts made several suggestions to other countries wishing to establish physical activity policies, e.g. regarding cross-sectoral support and coordination, comprehensive national action plans, and monitoring/surveillance.

CONCLUSIONS

This study provides a detailed overview of physical activity policies in the four countries. Results show that national governments are already very active in the field but that there is room for improvement in a number of areas, e.g. regarding the contribution of sectors beyond sport and health. Using the HEPA PAT simultaneously in four countries also showed that procedures and timelines have to be adapted to national contexts. Overall, the instrument can make an important contribution to understanding and informing physical activity policy, especially when used as an add-on to regular monitoring tools like the EU HEPA Monitoring Framework.

National physical activity and sedentary behaviour policies in 76 countries: availability, comprehensiveness, implementation, and effectiveness

Background

Evidence on current, national physical activity (PA) and sedentary behaviour (SB) policies is limited. We, therefore, analysed availability, comprehensiveness, implementation, and effectiveness of PA and SB policies internationally.

Methods

In this cross-sectional study, Global Observatory for Physical Activity (GoPA!) Country Contacts from 173 countries were asked to provide data on their national PA and SB policies by completing GoPA! Policy Inventory. Data were collected for 76 countries (response rate = 44%).

Results

Formal written policies for PA and SB were found in 92% (95% confidence interval [CI]: 86, 98) and 62% (95% CI: 50, 75) of countries, respectively. Sixty-two percent (95% CI: 51, 73) of countries have national PA guidelines, while 40% (95% CI: 29, 52) have SB guidelines. Fifty-two (95% CI: 40, 64) and 11% (95% CI: 3, 19) of countries have quantifiable national targets for PA and SB, respectively. The most represented ministries/departments involved in the promotion of more PA and/or less SB were in the sport (reported by 99% countries; 95% CI: 96, 100), health (97%; 95% CI: 94, 100), education (94%; 95% CI: 88, 100), and recreation and leisure (85%; 95% CI: 71, 99) sectors. The median score (0–10) for the comprehensiveness of PA and SB policies was 4 (95% CI: 4, 5) and 2 (95% CI: 2, 3), respectively. For PA and SB policy implementation it was 6 (95% CI: 5, 6). For the effectiveness of PA and SB policies it was 4 (95% CI: 3, 5) and 3 (95% CI: 2, 4), respectively. PA and SB policies were generally best developed in high-income countries and countries of European and Western-Pacific regions.

Conclusions

Most of the included countries have PA policies, but their comprehensiveness, implementation, and effectiveness are generally low-to-moderate. SB policies are less available, comprehensive, implemented, and effective than PA policies. PA and SB policies are better developed in high-income countries, compared with low- and lower-middle-income countries, and in countries of European and Western-Pacific regions, compared with other world regions. More investment is needed in development and implementation of comprehensive and effective PA and SB policies, particularly in low- and lower-middle-income countries.

Behavioral Model of Middle-Aged and Seniors for Bicycle Tourism

This research centers on the behavioral tendency of the middle-aged and seniors in bicycle tourism at environmentally protected scenic areas and its relevant influence factors. The theory of planned behavior (TPB) is adopted as the basis of this study. The middle-aged and seniors are the subjects of this research. A questionnaire survey is conducted at environmentally protected national scenic areas in Taiwan. A total of 230 samples are drawn with a random sampling method, and 210 are valid. The findings indicate two things. First, when applying the TPB to different fields of the study, the level of predictability may vary. Another finding is that subjective norm shows a higher level of susceptibility to sport habit and predictability to behavioral intention than the other two constructs. With an empirical analysis, the study is able to provide middle-aged and senior participants and sport administration authorities with relevant suggestions for reference at the end of this paper.

A systematic review of instruments for the analysis of national-level physical activity and sedentary behaviour policies

Background

This systematic review aimed to identify and critically assess available instruments for the analysis of national-level physical activity (PA) and sedentary behaviour (SB) policies and provide recommendations for their future use.

Methods

We conducted a systematic search of academic and grey literature through six bibliographic databases, Google and the websites of three international organisations for PA promotion to identify instruments that are used or that may be used for national-level PA/SB policy analysis. In order to describe and categorise the identified instruments, we used the Comprehensive Analysis of Policy on Physical Activity framework. This framework specifies the elements of a comprehensive analysis of PA/SB policies through the following categories: purpose, level, policy sector, type of policy, stages of policy cycle and scope of analysis.

Results

Out of 22,071 screened items, 26 publications describing 16 instruments met the selection criteria. All the instruments can be used for analysing PA policy, whilst only two include questions about SB policy. None of the instruments allow for the analysis of all the relevant components of national PA/SB policy. Some important elements of PA policy analysis, such as the tourism and research sectors, the agenda-setting and endorsement/legitimisation stages, and the effects of policy, are addressed by only a few instruments. Moreover, none of the instruments address unwritten formal statements, informal policies, and the termination and succession stages of the policy cycle.

Conclusion

Designing new instruments or adapting existing ones is needed to allow for a more thorough analysis of national PA and SB policies. Given that policy analysis covering all important components of PA/SB policy may be extremely time-consuming, a way forward might be to develop a set of complementary instruments, with each tool collecting detailed information about a specific component.